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Provision of community care: Who, what, how much?

Key points

Increasing the use of community care – which currently accounts for about £1 in every £10 spent by health care commissioners in England – relative to acute care has been a policy priority for almost as long as there has been an NHS.

In recent years, spending on community care delivered by non-NHS providers has increased substantially – and faster than in any other any area of NHS care. But surprisingly little is known about who is providing these services, or the size and scope of the contracts.

Our analysis is based on August 2016 FOI requests sent to all CCGs in England. We asked for details on who was currently providing their community services, the type of provider providing these services, what services they were providing, how much the contract was worth and the length of the contract. We received details of 7,494 contracts from 161 CCGs (78% of all CCGs).

We found that NHS providers hold over half (53%) of the total annual value of contracts awarded for community services. Contracts are also provided by organisations including general practices, local authorities, charities and private companies.

Of the community care contracts in our sample, private providers held 5% of the total annual value, but 39% of the total number of contracts issued.

Private providers tended to hold much smaller contracts, with 6 in 10 holding contracts with a combined value of less than £100,000. Additionally, most (7 in 10) held just one contract. The majority of very large contracts were held by the NHS.

Much more will need to be done to understand this sector better – both to understand the capacity and capability of CCGs to successfully commission community care from such a large and varied group of providers, and to assess the quality of care. This is particularly important as the direction of policy encourages a shift of care out of hospitals and into the community.

This briefing analyses information on the community care contracts held by 78% of clinical commissioning groups (CCGs) in England to enable better understanding of the provision of these services.

Following a Freedom of Information (FOI) request, we found NHS providers held more than half of the total annual value of contracts in our sample, while private providers held 5% of the total annual value, but 39% of the total number of contracts issued. Private providers tended to hold much smaller contracts, with 6 in 10 holding contracts with a combined value of less than £100,000. Additionally, most held just one contract.